Willie Penrose (Westmeath, Labour)
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Question 101: To ask the Tánaiste and Minister for Health and Children if all social welfare recipients whose sole income is social welfare are in receipt of a medical card; her views on whether recent social welfare increases may disqualify certain recipients from a medical card; and if she will make a statement on the matter. [33455/04]

Mary Harney (Dublin Mid West, Progressive Democrats)
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Entitlement to health services is primarily based on residency and means. The determination of eligibility for medical cards is the responsibility of the Health Service Executive. Other than for persons aged 70 years and over who are automatically entitled to a medical card, medical cards are issued to persons who, in the opinion of the executive, are unable to provide general practitioner medical and surgical services for themselves and their dependants without undue hardship.

It was the practice for former CEOs of health boards to draw up income guidelines each year to assist in the determination of a person's eligibility for a medical card. This function now rests with the executive. New income guidelines were agreed with effect from 1 January 2005, taking on board the announcement in the 2005 health Estimate to extend medical card coverage to up to 30,000 extra individuals. The new income guidelines represent an increase of approximately 7.5% over the 2004 guidelines and, with a view to assisting families on low income with children, the income allowance for each of the first two children was increased by approximately 20% and for the third and subsequent children by approximately 30%.

The executive has advised that a social welfare recipient whose sole income is a social welfare payment will be within the income threshold for receiving a medical card. Increases in social welfare rates in recent years have meant that such rates may exceed the income guidelines for a medical card. On foot of this, the Department of Health and Children wrote to the chairman of the group of former health board chief executive officers on a number of occasions asking him to advise the CEOs of concerns that medical card holders should not be disadvantaged by virtue of increases in social welfare payments announced in the budget. They were asked to ensure that increases in social welfare payments do not lead to medical card holders losing their medical cards by reference to the income guidelines and to make every effort to ensure that medical card holders and applicants are made aware that increases in social welfare payments will not disadvantage them when applying to hold or retain a medical card.

In the context of the announcements in the 2005 health Estimates on the extension of medical card coverage, it was further clarified that the instruction about medical card holders not being disadvantaged by virtue of increases in social welfare payments would continue to apply. It should be noted that the income guidelines are not statutorily binding. A medical card may still be awarded even though a person's income exceeds the guidelines if the executive considers that his or her medical needs or other circumstances justify it. It is open to all persons to apply to the executive for health services if they are unable to provide the services for themselves or their dependants without hardship.